Approaches to the diagnosis and management of primary hyperparathyroidism in Europe results from a European Survey in five countries

Stuart Ralston & Bente Langdahl

1Head of the School of Molecular and Clinical Medicine and ARC Professor of Rheumatology, Molecular Medicine Centre, Edinburgh, Scotland, UK; 2Department of Endocrinology and Metabolism, Aarhus University Hospital, DK-800 Aarhus C, Denmark.

Background: Primary hyperparathyroidism (PHPT) is a common condition, which in some patients can lead to complications such as osteoporosis and renal stones. This survey investigated diagnosis and treatment strategies for PHPT across Europe.

Methods: The survey was conducted in five European countries (France, Germany, UK, Italy and Spain). 286 of the 421 interviewed physicians were endocrinologists; the remainder were rheumatologists (46), internists (50) and urologists (39). Survey topics included: perception of the severity of the disease, referral for parathyroidectomy (PTX), diagnosis and treatment.

Results: Diagnostic methods were similar across Europe with serum PTH and serum calcium being the most common diagnostic tests (>94% of cases). Urinary calcium was measured in 8090% of patients. About 50% of physicians in each country followed national guidelines for treatment. Most physicians (66%) thought that not treating PHPT has serious implications. PTX was considered to be the therapy of choice for symptomatic patients by most respondents (77%). About half of the respondents (53%) recommended surgery in asymptomatic patients only if they meet specific criteria. 37% delayed surgery where possible and conducted regular follow-ups and/or treated pharmacologically. The respondents reported that about 43% of PHPT patients did not wish to undergo surgery and in 28% contraindications to surgery were identified. The respondents reported that approximately 10% of patients had a failed PTX. Regarding the pharmacological treatment, about half of all PHPT patients (49%) received bisphosphonates in combination with a diuretic (17%); about 13% had received a calcimimetic and 18% hormone-replacement therapy. Physicians in Italy (32%) and UK (28%) were more likely to treat asymptomatic patients pharmacologically than those in Spain (14%), France (14%) and Germany (13%).

Conclusion: The survey has demonstrated that although the approach to diagnosis of PHPT is similar across Europe, there are some notable differences in the pharmacological treatment of asymptomatic patients.